Clinical benefit of MAO-B and COMT inhibition in Parkinson's disease: practical considerations

J Neural Transm (Vienna). 2023 Jun;130(6):847-861. doi: 10.1007/s00702-023-02623-8. Epub 2023 Mar 24.

Abstract

Inhibitors of monoamine oxidase B (MAO-B) and catechol-O-methyltransferase (COMT) are major strategies to reduce levodopa degradation and thus to increase and prolong its effect in striatal dopaminergic neurotransmission in Parkinson's disease patients. While selegiline/rasagiline and tolcapone/entacapone have been available on the market for more than one decade, safinamide and opicapone have been approved in 2015 and 2016, respectively. Meanwhile, comprehensive data from several post-authorization studies have described the use and specific characteristics of the individual substances in clinical practice under real-life conditions. Here, we summarize current knowledge on both medication classes, with a focus on the added clinical value in Parkinson's disease. Furthermore, we outline practical considerations in the treatment of motor fluctuations and provide an outlook on ongoing studies with MAO-B and COMT inhibitors.

Keywords: COMT inhibitors; MAO-B inhibitors; Motor fluctuations; Parkinson’s disease.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antiparkinson Agents / pharmacology
  • Antiparkinson Agents / therapeutic use
  • Catechol O-Methyltransferase / metabolism
  • Catechol O-Methyltransferase Inhibitors / pharmacology
  • Catechol O-Methyltransferase Inhibitors / therapeutic use
  • Humans
  • Levodopa / therapeutic use
  • Monoamine Oxidase / metabolism
  • Monoamine Oxidase Inhibitors / pharmacology
  • Monoamine Oxidase Inhibitors / therapeutic use
  • Parkinson Disease* / drug therapy

Substances

  • Antiparkinson Agents
  • Monoamine Oxidase
  • Catechol O-Methyltransferase
  • Levodopa
  • Catechol O-Methyltransferase Inhibitors
  • Monoamine Oxidase Inhibitors
  • COMT protein, human